Health Care Claim Reason and Group Codes List
Reason
Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Adjustment
Group Code
Description
CO
CR
OA
PI
PR
Contractual Obligation
Corrections and Reversal
Other Adjustment
Payer Initiated Reductions
Patient Responsibility
Description
Deductible Amount
Coinsurance Amount
Co-payment Amount
The procedure code is inconsistent with the modifier used or a required modifier is
missing.
The procedure code/bill type is inconsistent with the place of service.
The procedure/revenue code is inconsistent with the patient's age.
The procedure/revenue code is inconsistent with the patient's gender.
The procedure code is inconsistent with the provider type/specialty (taxonomy).
The diagnosis is inconsistent with the patient's age.
The diagnosis is inconsistent with the patient's gender.
The diagnosis is inconsistent with the procedure.
The diagnosis is inconsistent with the provider type.
The date of death precedes the date of service.
The date of birth follows the date of service.
The authorization number is missing, invalid, or does not apply to the billed services or
provider.
Claim/service lacks information or has submission/billing error(s) which is needed for
adjudication.
Requested information was not provided or was insufficient/incomplete.
Exact duplicate claim/service
This is a work-related injury/illness and thus the liability of the Worker's Compensation
Carrier.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
Description
20
21
22
23
This injury/illness is covered by the liability carrier.
This injury/illness is the liability of the no-fault carrier.
This care may be covered by another payer per coordination of benefits.
The impact of prior payer(s) adjudication including payments and/or adjustments.
24
25
26
27
28
29
30
Charges are covered under a capitation agreement/managed care plan.
Payment denied. Your Stop loss deductible has not been met.
Expenses incurred prior to coverage.
Expenses incurred after coverage terminated.
Coverage not in effect at the time the service was provided.
The time limit for filing has expired.
Payment adjusted because the patient has not met the required eligibility, spend down,
waiting, or residency requirements.
Patient cannot be identified as our insured.
Our records indicate that this dependent is not an eligible dependent as defined.
Insured has no dependent coverage.
Insured has no coverage for newborns.
Lifetime benefit maximum has been reached.
Balance does not exceed co-payment amount.
Balance does not exceed deductible.
Services not provided or authorized by designated (network/primary care) providers.
Services denied at the time authorization/pre-certification was requested.
Charges do not meet qualifications for emergent/urgent care.
Discount agreed to in Preferred Provider contract.
Charges exceed our fee schedule or maximum allowable amount.
Gramm-Rudman reduction.
Prompt-pay discount.
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee
arrangement.
This (these) service(s) is (are) not covered.
This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
This (these) procedure(s) is (are) not covered.
This is a non-covered service because it is a routine/preventive exam or a
diagnostic/screening procedure done in conjunction with a routine/preventive exam.
These are non-covered services because this is not deemed a 'medical necessity' by the
payer.
These are non-covered services because this is a pre-existing condition.
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
52
53
Description
The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform
the service billed.
Services by an immediate relative or a member of the same household are not covered.
54
55
56
57
Multiple physicians/assistants are not covered in this case.
Procedure/treatment is deemed experimental/investigational by the payer.
Procedure/treatment has not been deemed 'proven to be effective' by the payer.
Payment denied/reduced because the payer deems the information submitted does not
support this level of service, this many services, this length of service, this dosage, or this
day's supply.
58
Treatment was deemed by the payer to have been rendered in an inappropriate or invalid
place of service.
Processed based on multiple or concurrent procedure rules.
Charges for outpatient services are not covered when performed within a period of time
prior to or after inpatient services.
Penalty for failure to obtain second surgical opinion.
Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
Correction to a prior claim.
Denial reversed per Medical Review.
Procedure code was incorrect. This payment reflects the correct code.
Blood Deductible.
Lifetime reserve days.
DRG weight.
Day outlier amount.
Cost outlier - Adjustment to compensate for additional costs.
Primary Payer amount.
Coinsurance day.
Administrative days.
Indirect Medical Education Adjustment.
Direct Medical Education Adjustment.
Disproportionate Share Adjustment.
Covered days.
Non-Covered days/Room charge adjustment.
Cost Report days.
Outlier days.
Discharges.
PIP days.
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
Description
Total visits.
Capital Adjustment.
Patient Interest Adjustment
Statutory Adjustment.
Transfer amount.
Adjustment amount represents collection against receivable created in prior overpayment.
Professional fees removed from charges.
Ingredient cost adjustment.
Dispensing fee adjustment.
Claim Paid in full.
No Claim level Adjustments.
Processed in Excess of charges.
Plan procedures not followed.
Non-covered charge(s).
The benefit for this service is included in the payment/allowance for another
service/procedure that has already been adjudicated.
The hospital must file the Medicare claim for this inpatient non-physician service.
Medicare Secondary Payer Adjustment Amount.
Payment made to patient/insured/responsible party/employer.
Predetermination: anticipated payment upon completion of services or claim adjudication.
Major Medical Adjustment.
Provider promotional discount
Managed care withholding.
Tax withholding.
Patient payment option/election not in effect.
The related or qualifying claim/service was not identified on this claim.
Rent/purchase guidelines were not met.
Claim/service not covered by this payer/contractor. You must send the claim/service to
the correct payer/contractor.
Billing date predates service date.
Not covered unless the provider accepts assignment.
Service not furnished directly to the patient and/or not documented.
Payment denied because service/procedure was provided outside the United States or as
a result of war.
Procedure/product not approved by the Food and Drug Administration.
Procedure postponed, canceled, or delayed.
The advance indemnification notice signed by the patient did not comply with
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
Description
requirements.
Transportation is only covered to the closest facility that can provide the necessary care.
ESRD network support adjustment.
Benefit maximum for this time period or occurrence has been reached.
Patient is covered by a managed care plan.
Indemnification adjustment - compensation for outstanding member responsibility.
Psychiatric reduction.
Payer refund due to overpayment.
Payer refund amount - not our patient.
Submission/billing error(s).
Deductible -- Major Medical.
Coinsurance -- Major Medical.
Newborn's services are covered in the mother's Allowance.
Prior processing information appears incorrect.
Claim submission fee.
Claim specific negotiated discount.
Prearranged demonstration project adjustment.
The disposition of the claim/service is pending further review.
Technical fees removed from charges.
Interim bills cannot be processed.
Failure to follow prior payer's coverage rules.
Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
Appeal procedures not followed or time limits not met.
Contracted funding agreement - Subscriber is employed by the provider of services.
Patient/Insured health identification number and name do not match.
Claim spans eligible and ineligible periods of coverage.
Monthly Medicaid patient liability amount.
Portion of payment deferred.
Incentive adjustment, e.g. preferred product/service.
Premium payment withholding.
Diagnosis was invalid for the date(s) of service reported.
Provider contracted/negotiated rate expired or not on file.
Information from another provider was not provided or was insufficient/incomplete.
Lifetime benefit maximum has been reached for this service/benefit category.
Payer deems the information submitted does not support this level of service.
Payment adjusted because the payer deems the information submitted does not support
this many/frequency of services.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
Description
Payer deems the information submitted does not support this length of service.
Payer deems the information submitted does not support this dosage.
Payer deems the information submitted does not support this day's supply.
Patient refused the service/procedure.
Flexible spending account payments. Note: Use code 187.
Service/procedure was provided as a result of an act of war.
Service/procedure was provided outside of the United States.
Service/procedure was provided as a result of terrorism.
Injury/illness was the result of an activity that is a benefit exclusion.
Provider performance bonus.
State-mandated Requirement for Property and Casualty, see Claim Payment Remarks
Code for specific explanation.
Attachment/other documentation referenced on the claim was not received.
Attachment/other documentation referenced on the claim was not received in a timely
fashion.
Referral absent or exceeded.
These services were submitted after this payers responsibility for processing claims under
this plan ended.
This (these) diagnosis(es) is (are) not covered.
Service(s) have been considered under the patient's medical plan. Benefits are not
available under this dental plan.
Alternate benefit has been provided.
Payment is denied when performed/billed by this type of provider.
Payment is denied when performed/billed by this type of provider in this type of facility.
Payment is adjusted when performed/billed by a provider of this specialty.
Service/equipment was not prescribed by a physician.
Service was not prescribed prior to delivery.
Prescription is incomplete.
Prescription is not current.
Patient has not met the required eligibility requirements.
Patient has not met the required spend down requirements.
Patient has not met the required waiting requirements.
Patient has not met the required residency requirements.
Procedure code was invalid on the date of service.
Procedure modifier was invalid on the date of service.
The referring provider is not eligible to refer the service billed.
The prescribing/ordering provider is not eligible to prescribe/order the service billed.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
Description
210
The rendering provider is not eligible to perform the service billed.
Level of care change adjustment.
Consumer Spending Account payments (includes but is not limited to Flexible Spending
Account, Health Savings Account, Health Reimbursement Account, etc.)
This product/procedure is only covered when used according to FDA recommendations.
'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when
there is a specific procedure code for this procedure/service.
Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
Not a work related injury/illness and thus not the liability of the workers' compensation
carrier.
Non standard adjustment code from paper remittance.
Original payment decision is being maintained. Upon review, it was determined that this
claim was processed properly.
Anesthesia performed by the operating physician, the assistant surgeon or the attending
physician.
Refund issued to an erroneous priority payer for this claim/service.
Claim/service denied based on prior payer's coverage determination.
Precertification/authorization/notification absent.
Precertification/authorization exceeded.
Revenue code and Procedure code do not match.
Expenses incurred during lapse in coverage.
Workers' Compensation case settled. Patient is responsible for amount of this
claim/service through WC 'Medicare set aside arrangement' or other agreement.
Non-covered personal comfort or convenience services.
Discontinued or reduced service.
This service/equipment/drug is not covered under the patient’s current benefit plan.
Pharmacy discount card processing fee.
National Provider Identifier - missing.
National Provider identifier - Invalid format.
National Provider Identifier - Not matched.
Per regulatory or other agreement. The provider cannot collect this amount from the
patient. However, this amount may be billed to subsequent payer. Refund to patient if
collected.
Payment adjusted because pre-certification/authorization not received in a timely fashion.
211
212
213
National Drug Codes (NDC) not eligible for rebate, are not covered.
Administrative surcharges are not covered.
Non-compliance with the physician self referral prohibition legislation or payer policy.
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
Description
Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for
claim or service/treatment.
Based on subrogation of a third party settlement.
Based on the findings of a review organization.
Based on payer reasonable and customary fees. No maximum allowable defined by
legislated fee arrangement.
Based on entitlement to benefits.
Based on extent of injury.
The applicable fee schedule/fee database does not contain the billed code. Please
resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe
the service(s) provided and supporting documentation if required.
Claim is under investigation.
Exceeds the contracted maximum number of hours/days/units by this provider for this
period. This is not patient specific.
Adjustment code for mandated federal, state or local law/regulation that is not already
covered by another code and is mandated before a new code can be created.
Patient identification compromised by identity theft. Identity verification required for
processing this and future claims.
Penalty or Interest Payment by Payer.
Information requested from the Billing/Rendering Provider was not provided or not
provided timely or was insufficient/incomplete.
Information requested from the patient/insured/responsible party was not provided or was
insufficient/incomplete.
Denied for failure of this provider, another provider or the subscriber to supply requested
information to a previous payer for their adjudication.
Partial charge amount not considered by Medicare due to the initial claim Type of Bill
being 12X.
No available or correlating CPT/HCPCS code to describe this service.
Mutually exclusive procedures cannot be done in the same day/setting.
Institutional Transfer Amount. Note - Applies to institutional claims only and explains the
DRG amount difference when the patient care crosses multiple institutions.
Services/charges related to the treatment of a hospital-acquired condition or preventable
medical error.
This procedure is not paid separately.
Sales Tax.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
Description
236
This procedure or procedure/modifier combination is not compatible with another
procedure or procedure/modifier combination provided on the same day according to the
National Correct Coding Initiative or workers compensation state regulations/ fee
schedule requirements.
237
238
Legislated/Regulatory Penalty.
Claim spans eligible and ineligible periods of coverage, this is the reduction for the
ineligible period.
Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
The diagnosis is inconsistent with the patient's birth weight.
Low Income Subsidy (LIS) Co-payment Amount
Services not provided by network/primary care providers.
Services not authorized by network/primary care providers.
Payment reduced to zero due to litigation. Additional information will be sent following the
conclusion of litigation.
Provider performance program withhold.
This non-payable code is for required reporting only.
Deductible for Professional service rendered in an Institutional setting and billed on an
Institutional claim.
Coinsurance for Professional service rendered in an Institutional setting and billed on an
Institutional claim.
This claim has been identified as a readmission.
The attachment/other documentation content received is inconsistent with the expected
content.
The attachment/other documentation content received did not contain the content
required to process this claim or service.
An attachment/other documentation is required to adjudicate this claim/service.
Sequestration - reduction in federal payment.
Claim received by the dental plan, but benefits not available under this plan. Submit these
services to the patient's medical plan for further consideration.
The disposition of the related Property & Casualty claim (injury or illness) is pending due
to litigation.
Service not payable per managed care contract.
The disposition of the claim/service is undetermined during the premium payment grace
period, per Health Insurance Exchange requirements. This claim/service will be reversed
and corrected when the grace period ends (due to premium payment or lack of premium
payment).
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
Claim/service not covered when patient is in custody/incarcerated. Applicable federal,
state or local authority may cover the claim/service.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
259
260
A0
A1
A2
A3
A4
A5
A6
A7
A8
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
B11
B12
B13
B14
B15
B16
B17
B18
B19
Description
Additional payment for Dental/Vision service utilization.
Processed under Medicaid ACA Enhanced Fee Schedule
Patient refund amount.
Claim/Service denied.
Contractual adjustment.
Medicare Secondary Payer liability met.
Medicare Claim PPS Capital Day Outlier Amount.
Medicare Claim PPS Capital Cost Outlier Amount.
Prior hospitalization or 30 day transfer requirement not met.
Presumptive Payment Adjustment.
Ungroupable DRG.
Non-covered visits.
Covered visits.
Covered charges.
Late filing penalty.
Coverage/program guidelines were not met or were exceeded.
This payment is adjusted when performed/billed by this type of provider, by this type of
provider in this type of facility, or by a provider of this specialty.
This provider was not certified/eligible to be paid for this procedure/service on this date of
service.
Alternative services were available, and should have been utilized.
Patient is enrolled in a Hospice.
Allowed amount has been reduced because a component of the basic procedure/test was
paid. The beneficiary is not liable for more than the charge limit for the basic
procedure/test.
The claim/service has been transferred to the proper payer/processor for processing.
Claim/service not covered by this payer/processor.
Services not documented in patients' medical records.
Previously paid. Payment for this claim/service may have been provided in a previous
payment.
Only one visit or consultation per physician per day is covered.
This service/procedure requires that a qualifying service/procedure be received and
covered. The qualifying other service/procedure has not been received/adjudicated.
'New Patient' qualifications were not met.
Payment adjusted because this service was not prescribed by a physician, not prescribed
prior to delivery, the prescription is incomplete, or the prescription is not current.
This procedure code and modifier were invalid on the date of service.
Claim/service adjusted because of the finding of a Review Organization.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
B20
B21
B22
B23
D1
D2
D3
D4
D5
D6
D7
D8
D9
D10
D11
D12
D13
D14
D15
D16
D17
D18
D19
D20
D21
D22
D23
P1
P2
Description
Procedure/service was partially or fully furnished by another provider.
The charges were reduced because the service/care was partially furnished by another
physician.
This payment is adjusted based on the diagnosis.
Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment
(CLIA) proficiency test.
Claim/service denied. Level of subluxation is missing or inadequate.
Claim lacks the name, strength, or dosage of the drug furnished.
Claim/service denied because information to indicate if the patient owns the equipment
that requires the part or supply was missing.
Claim/service does not indicate the period of time for which this will be needed.
Claim/service denied. Claim lacks individual lab codes included in the test.
Claim/service denied. Claim did not include patient's medical record for the service.
Claim/service denied. Claim lacks date of patient's most recent physician visit.
Claim/service denied. Claim lacks indicator that 'x-ray is available for review.'
Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the
lens, less discounts or the type of intraocular lens used.
Claim/service denied. Completed physician financial relationship form not on file.
Claim lacks completed pacemaker registration form.
Claim/service denied. Claim does not identify who performed the purchased diagnostic
test or the amount you were charged for the test.
Claim/service denied. Performed by a facility/supplier in which the ordering/referring
physician has a financial interest.
Claim lacks indication that plan of treatment is on file.
Claim lacks indication that service was supervised or evaluated by a physician.
Claim lacks prior payer payment information.
Claim/Service has invalid non-covered days.
Claim/Service has missing diagnosis information.
Claim/Service lacks Physician/Operative or other supporting documentation
Claim/Service missing service/product information.
This (these) diagnosis(es) is (are) missing or are invalid
Reimbursement was adjusted for the reasons to be provided in separate correspondence.
This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility.
State-mandated Requirement for Property and Casualty, see Claim Payment Remarks
Code for specific explanation.
Not a work related injury/illness and thus not the liability of the workers' compensation
carrier.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
P3
P4
P5
P6
P7
P8
P9
P10
P11
P12
P13
P14
P15
P16
P17
P18
P19
P20
P21
Description
Workers' Compensation case settled. Patient is responsible for amount of this
claim/service through WC 'Medicare set aside arrangement' or other agreement.
Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for
claim or service/treatment.
Based on payer reasonable and customary fees. No maximum allowable defined by
legislated fee arrangement.
Based on entitlement to benefits.
The applicable fee schedule/fee database does not contain the billed code. Please
resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe
the service(s) provided and supporting documentation if required.
Claim is under investigation.
No available or correlating CPT/HCPCS code to describe this service.
Payment reduced to zero due to litigation. Additional information will be sent following the
conclusion of litigation.
The disposition of the related Property & Casualty claim (injury or illness) is pending due
to litigation.
Workers' compensation jurisdictional fee schedule adjustment.
Payment reduced or denied based on workers' compensation jurisdictional regulations or
payment policies, use only if no other code is applicable.
The Benefit for this Service is included in the payment/allowance for another
service/procedure that has been performed on the same day.
Workers' Compensation Medical Treatment Guideline Adjustment.
Medical provider not authorized/certified to provide treatment to injured workers in this
jurisdiction. To be used for Workers' Compensation only.
Referral not authorized by attending physician per regulatory requirement.
Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a
comparable service.
Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no
payment is due. To be used for Property and Casualty only.
Service not paid under jurisdiction allowed outpatient facility fee schedule.
Payment denied based on Medical Payments Coverage (MPC) or Personal Injury
Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other
code is applicable.
P22
Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury
Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other
code is applicable.
P23
Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits
jurisdictional fee schedule adjustment.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320
Reason
Code
W1
W2
W3
W4
W5
W6
W7
W8
W9
Y1
Description
Workers' compensation jurisdictional fee schedule adjustment.
Payment reduced or denied based on workers' compensation jurisdictional regulations or
payment policies, use only if no other code is applicable.
The Benefit for this Service is included in the payment/allowance for another
service/procedure that has been performed on the same day.
Workers' Compensation Medical Treatment Guideline Adjustment.
Medical provider not authorized/certified to provide treatment to injured workers in this
jurisdiction. (Use with Group Code CO or OA)
Referral not authorized by attending physician per regulatory requirement.
Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a
comparable service.
Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no
payment is due.
Service not paid under jurisdiction allowed outpatient facility fee schedule.
Payment denied based on Medical Payments Coverage (MPC) or Personal Injury
Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other
code is applicable.
Y2
Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury
Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other
code is applicable.
Y3
Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits
jurisdictional fee schedule adjustment.
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services
provided by United HealthCare Services, Inc. or its affiliates.
Doc#: PCA11861_ 20140320